John Unsworth

Aim: To explore the relationship between professional regulatory systems and advanced practice nursing development in Europe. Background: Advanced practice nursing has expanded rapidly, yet regulatory frameworks have often struggled to keep pace with the extended scope of practice demanded by contemporary service delivery. Misalignment leaves new roles inadequately supported, with consequences for both patient safety and the broader transformative potential of the profession. Methods: For this cross‐sectional descriptive study, key informants were recruited by purposive sampling across the World Health Organization's Europe Office member countries, including regulators, educators and nursing association representatives. A purpose‐built questionnaire was analysed using descriptive statistics and pattern comparison. Results: The majority of European countries have advanced practice nursing roles, yet scope of practice and accompanying regulatory mechanisms varied considerably. Independent prescribing authority was the least commonly reported characteristic, having been established in only four countries. An observed descriptive pattern indicated that role maturity was related to government‐led or statutory regulation designed specifically to address extended clinical skills. Interest‐holders were largely in favour of regulatory intervention. Conclusion: Regulatory modernisation is a key step for health systems seeking to expand advanced practice nursing. Legal scopes of practice must be realigned with clinical realities. In this sample, reported independent prescribing authority co ‐occurred with government led or legally mandated regulatory arrangements. Implications for Nursing: Nursing organisations should advocate for mandatory frameworks encompassing title protection, standardised educational requirements and competency standards for high‐risk clinical skills, such as independent diagnosis and prescribing. Implications for Health Policy: Governments should establish statutory advanced practice frameworks, with nursing leadership within government playing a key role.

Introduction: Vaccine hesitancy is relevant among nursing students, as they move across healthcare and university settings. Given the opportunity of social media to disseminate misleading information to users and the exposure of the digital natives, social media addiction (SMA) is considered a predictor of vaccine hesitancy, although to date no research within this specific population exists. Purpose: To investigate the role of SMA on vaccine hesitancy in nursing students. Design: Cross‐sectional. Method: Structural Equation Modelling was adopted to test the study's aim. The VAX scale was used among 227 nursing students in the UK regarding COVID‐19 and Influenza vaccines during the period from March to July 2023. The Bergen Social Media Addiction scale was adopted to measure SMA. Results: Statistically significant results were found between SMA and mistrust of vaccine benefits. No significant correlations were found between SMA and concerns about unforeseen future effects or a preference for natural immunity. Regarding concerns about commercial profiteering, there was a significant negative correlation for the COVID‐19 vaccine. Conclusion: Mistrust in institutions and scepticism towards vaccine benefits and commercial interests are recurring issues tied to social media. Targeting popular social media platforms for tailored vaccination campaigns is recommended to promote vaccine acceptance among nursing students. Implications for the Profession and/or Patient Care: Providing accurate and accessible vaccine information on social media platforms, promoting media literacy and engaging with individuals to address their concerns are key to promoting vaccination among nursing students. Impact: This study provides new strategies for tailoring vaccination campaigns and policies. Public health efforts to combat vaccine hesitancy should consider the role of social media and work to provide accurate and balanced information to the public. Reporting Method: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted. Patient or Public Contribution: No patient or public contribution.

Background: The debate about whether health visiting, a specialist community public health nursing role, is at the level of advanced practice nurse has gone on for more than a decade. There is little empirical evidence that the role matches the traditional role of an advanced practice nurse, although many of the attributes of advanced practice nursing such as prescribing rights, managing complex cases, caseloads with undifferentiated need and advanced assessment and decision‐making are certainly present. Aim: The current study aimed to develop, refine and test the Health Visiting Advanced Practice Scale to assess the scope of advanced practice of UK health visitors. Design: A cross‐sectional and methodological scale validation design, following classical test theory. Methods: The design consisted of three phases; the first involved scale development including item generation, phase two assessed the content validity index, and the third phase involved a cross‐sectional survey to establish construct validity, content validity, and internal consistency reliability, and conduct exploratory and confirmatory factor analysis. Results: The initial 44‐item scale underwent iterative exploratory and confirmatory factor analyses, leading to a refined 5‐factor structure with 29 items covering domains such as family‐centred care, leadership, prescribing, diagnostic reasoning, and professional practice. This final version demonstrated strong reliability and construct validity in the EFA but mixed fit indices in the CFA, supporting both internal consistency and validity of the scale. Conclusion: The final scale offers a rigorously validated tool for assessing advanced practice among UK health visitors, capturing core domains such as family‐centred care, leadership, prescribing, and diagnostic reasoning. By bridging theoretical frameworks with real‐world practice, it fills a critical gap in evaluating and supporting the professional scope of this public health nursing specialty. Impact: These findings provide valid and reliable insights for measuring and improving health visitors' advanced practice and developing future professional policies. Patient or Public Contribution: No patient or public contribution. Reporting Method: STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross‐sectional studies.

Patient safety is a critical concern in healthcare, with preventable adverse events contributing significantly to morbidity and mortality. Digital health interventions (DHIs) are increasingly integrated into healthcare systems to improve patient safety outcomes. However, their effectiveness remains unclear. This study focuses on DHIs adopted by patients and, in detail, it aims to assess the effectiveness of patient-facing DHIs in improving patient safety outcomes, including medication adherence, healthcare utilization, falls, mortality, adverse events, relapse rate, and readmissions. This meta-analysis of meta-analyses follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and it is registered in PROSPERO. The eligible meta-analyses were identified across major databases (PubMed, Web of Science, Cochrane Reviews, EPISTEMONIKOS, CINAHL, ProQuest, Scopus, PsychARTICLES) from 2010 until 2024. The quantitative synthesis adopted a random-effects model. The corrected covered area method quantified the studies’ overlap and heterogeneity was assessed using the I2 statistic. Publication bias was examined using Egger’s test. The JBI Critical Appraisal Checklist was adopted. In total, 72 meta-analyses were included. Findings indicate that patient-facing DHIs improve medication adherence (SMD = 0.33; 95% CI = 0.22–0.44), reduce mortality risk (RR = 0.84; 95% CI = 0.78–0.90) and hospital readmissions (RR = 0.90; 95% CI = 0.81–0.98). Additionally, patient-facing DHIs reduce fall risk among older adults (SMD = 0.30; 95% CI = 0.13–0.46). However, the impact on healthcare utilization reported increased patient visits, while relapse rate (RR = 1.00; 95% CI = 0.87–1.16) and adverse events (RR = 0.94; 95% CI = 0.66–1.34) showed no significant association with patient-facing DHIs. While these digital solutions demonstrate the potential to enhance medication adherence, reduce mortality, and prevent falls, their effectiveness varies. Challenges such as usability issues, digital literacy gaps, and infrastructure limitations should be addressed to optimize patient safety outcomes.

Introduction: Advanced practice nursing is key in response to increasing healthcare demands and the need for Universal Health Coverage. District nursing, which involves care for people in their own homes, has undergone a significant transformation to manage complex long‐term conditions and reduce hospital admissions. Aim: This study aims to identify the advanced practice domains of UK district nurse team leaders, before and after policy reforms designed to prevent unnecessary admission to hospital. A secondary aim is to compare the advanced practice domains of district nurse team leaders with those of advanced practice nurses working in family and community nursing. Methods: A cross‐sectional study was conducted. Data were collected via an online survey using the Family and Community Nursing Advanced Practice Scale, assessing five key domains of advanced practice. The study employed ANOVA and t ‐tests to compare groups. Results: A total of 448 district nurse team leaders participated in this study, and secondary data from 548 family and community nurses were retrieved. No significant differences were found across qualification groups for most advanced practice domains, except for medication prescribing. Comparisons with advanced practice nurses in family and community settings revealed significantly higher scores in all domains and similar scores in leadership competencies. Discussion: Experiential learning plays a crucial role in developing advanced practice competencies beyond formal qualifications. The results align with Kolb's theory, highlighting the importance of clinical exposure and mentorship in shaping advanced nursing skills. Conclusion: District nurse team leaders exhibit key advanced practice competencies. Credentialing frameworks may help formally recognise the expertise developed through clinical experience. Implications for nursing and health policy: Policymakers should consider enhancing experiential learning opportunities and credentialing systems to support district nurses in their transition to advanced practice.